Comparative efficacy of digital cognitive behavioral therapy for insomnia: A systematic review and network meta-analysis

Faizul Hasan; Yu-Kang Tu; Chien-Ming Yang; Christopher James Gordon; Dean Wu; Hsin-Chien Lee; Lia Taurussia Yuliana; Lucky Herawati; Ting-Jhen Chen; Hsiao-Yean Chiu

doi:10.1016/j.smrv.2021.101567

Comparative efficacy of digital cognitive behavioral therapy for insomnia: A systematic review and network meta-analysis

Sleep Med Rev. 2022 Feb:61:101567. doi: 10.1016/j.smrv.2021.101567. Epub 2021 Nov 10.

Authors

Affiliations

¹ School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
² Department of Public Health, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
³ Department of Psychology, National Cheng-Chi University, Taipei, 116, Taiwan; The Research Center for Mind, Brain, and Learning, National Cheng-Chi University, Taipei, Taiwan.
⁴ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; CIRUS Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, Australia.
⁵ Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁶ Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan.
⁷ School of Public Health Education, Politeknik Kesehatan Kemenkes Yogjakarta, Indonesia.
⁸ School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: hychiu0315@tmu.edu.tw.

PMID: 34902820
DOI: 10.1016/j.smrv.2021.101567

Abstract

The comparative efficacy of various approaches of digital cognitive behavioral therapy for insomnia (CBTi) is still unclear. This network meta-analysis explored the comparative efficacy of digital CBTi approaches in adults with insomnia. Four electronic databases were searched from inception to June 27, 2020. Primary outcomes were self-reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), and insomnia symptoms; these were measured using sleep diaries or valid questionnaires. A random-effects network meta-analysis in a frequentist framework was used. Fifty-four randomized controlled trials comprising 11,815 participants were included. Compared with usual care, web-based CBTi with a therapist demonstrated significantly longer TST (mean difference [MD]: 23.19 min, 95% confidence interval [CI]: 18.98-27.39 min), shorter SOL (MD: -18.76 min, 95% CI -24.20 to -13.31 min), lower WASO (MD: -31.40 min, 95% CI: -36.26 to -26.55 min), and greater SE (MD: 10.37%, 95% CI: 8.08%-12.65%). The surface under the cumulative ranking curve indicates that web-based CBTi with therapists is most likely to be ranked the highest among all treatments, and thus, this network meta-analysis suggests that such a treatment is the optimal intervention for improving sleep duration and SE as well as the reductions in SOL and WASO. PROSPERO REGISTRATION NUMBER: CRD42020171134.

Keywords: Adults; Cognitive behavioral therapy for insomnia; Digital CBTi; Insomnia; Network meta-analysis.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Adult
Cognitive Behavioral Therapy*
Humans
Network Meta-Analysis
Polysomnography
Randomized Controlled Trials as Topic
Self Report
Sleep
Sleep Initiation and Maintenance Disorders* / therapy
Treatment Outcome